Retzius-sparing Robot-assisted Laparoscopic Radical Research Articles

A novel pelvis-prostate model BPPP predicts immediate urinary continence after Retzius-sparing robotic-assisted laparoscopic radical prostatectomy

This study aimed to construct a novel pelvis-prostate model BPPP which consists of body mass index (BMI), prostate volume (PV), pelvic cavity index (PCI) and prostate-muscle index (PMI) to predict the immediate urinary continence after Retzius-sparing robot assisted laparoscopic radical prostatectomy (RS-RARP). The perioperative data of patients with prostate cancer who underwent RS-RARP in the department of urology of Nanjing Drum Tower Hospital from June 2018 to June 2022 were retrospectively analyzed. 280 patients were eligible for this study in total. Multivariate analysis showed that BMI, PV, PCI, PMI and NVB preservation were significantly associated with immediate urinary continence after RS-RARP. Subgroup analysis showed that patients with low BMI, low PV, high PCI and high PMI had a higher recovery rate of immediate urinary continence. The area under the curve of BPPP (BMI + PV + PCI + PMI) for predicting the immediate recovery of urinary continence after RS-RARP was 0.726. Delong test showed that the area under the curve of the combined test for predicting the immediate urinary continence after RS-RARP was better compared with single parameter (p < 0.05). In conclusion the novel pelvis-prostate model BPPP may predict the immediate urinary continence after RS-RARP, providing information for preoperative decision-making.

Surgical Experience and Results of Retzius Sparing Robotic Assisted Laparoscopic Radical Prostatectomy: First Report in Thailand

Objective: To evaluate the outcomes and safety of the surgical technique Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALRP), with prostatic cancer; the first report in Thailand. Material and Methods: The authors conducted a retrospective analysis from the medical records of 100 patients who underwent RS-RALRP by a single surgeon; from 1st January 2021 until 31st May 2023, at Rajavithi Hospital. The authors analyzed demographic data, clinical staging, Gleason grade group, operative time, pathologic staging, positive surgical margin rate; postoperative continence recovery and postoperative complications. Results: The median age was 71.34±6.84 years: mean total PSA was 17.16±17.55 ng/ml; with the majority in clinical T1 and T2. The mean operative time was 221.7±51.93 minutes, and the mean estimated blood loss was 312.30±264.55 ml. Of all patients, 88% did not require blood transfusion. The complication rate was 8%. The pathologic stages pT2 and pT3 or greater were 62% and 38%, respectively. Positive surgical margins (PSM) pT2 and pT3 were 14.5% and 63.2%. The postoperative continence recovery after RS-RALRP were 83%, 95%, 97%,100% and 100%: at 1, 3, 6, 9 and 12 months postoperatively, respectively. Conclusion: RS-RALRP has a potential to become the new standard for prostate cancer treatment, with improved early continence and equivalent oncologic efficacy. The limitations of this study are the small number of population, which require prospective multicenter studies.

Intermediate-Term Oncologic Outcome Assessment for Robot-Assisted Radical Prostatectomy: Comparing Retzius-Sparing with Standard Approach in a Randomized Control Cohort.

Introduction: Retzius-sparing prostatectomy was promoted with the early continence result. The long-term oncologic outcome is still unknown. In this study, we aimed to compare the intermediate-term oncologic outcomes of these two approaches in patients' cohort who were treated as part of a randomized controlled trial. Methods: A total of 120 patients were previously randomized equally to receive Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) vs standard robot-assisted laparoscopic radical prostatectomy (S-RARP) between January 2015 and April 2016. Baseline, surgical, and pathologic characteristics as well as oncologic outcomes were assessed. The analysis was done based on the treatment received. Result: Sixty-three patients underwent S-RARP, whereas 57 patients underwent RS-RARP. There was no statistically significant difference in the baseline nor surgical characteristics. The median follow-up was 71.24 (interquartile range: 59.75-75.75) months. There were more pathologic T3 diseases in RS-RARP. There was no significant difference in the positive margin status nor in the biochemical recurrence (BCR) rate among both groups. After S-RARP and RS-RARP, 6 and 10 patients had BCR, and the 5 years BCR-free survival was 91% and 85%, respectively (p = 0.21). Conclusion: In this cohort, there was no difference in BCR in the patients who received either technique. Further multi-institutional studies with a larger sample size and longer follow-up are required.

PE023 - Clinical efficacy of Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

PE023 - Clinical efficacy of Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle

Comparing Revo-i and da Vinci in Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Preliminary Propensity Score Analysis of Outcomes.

Purpose: This study aims to compare perioperative and oncologic outcomes between matched cohorts of localized prostate cancer (PCa) operated on by the same surgeon using the da Vinci Si robot and the Revo-i robot. Materials and Methods: Nonmetastatic PCa patients undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) from January 2016 to December 2020 were matched one-to-one (33:33) to da Vinci Si controls using propensity score matching according to the following covariates: age, American Society of Anesthesiology (ASA) score, body mass index, previous abdominal and endoscopic surgery, preoperative prostate specific antigen, prostate volume, Gleason grade group, tumor stage, and need for pelvic lymphadenectomy. Outcomes of interest were estimated blood loss, length of stay, complication rate, operative times, positive surgical margins, and biochemical recurrence at 6 months. Results: Both cohorts were similar in estimated blood loss, rate of margin positivity, and rate of complications. Length of stay was significantly shorter with the Revo-i cohort. The da Vinci robot showed faster console, suture, and total operation times. Positive margin rate and biochemical recurrence at 6 months were similar in both groups. Conclusion: Despite the longer suture, console, and operative time those in the da Vinci robot in the authors' institution, the Revo-i robot-assisted radical prostatectomy had equivalent short-term oncologic outcomes with the da Vinci standard.

Is Retzius-sparing robot-assisted laparoscopic radical prostatectomy effective in early continence? A single-center experience of the first 50 patients.

In this study, we aimed to present the perioperative and postoperative outcomes and early continence rates of the first 50 patients who underwent Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) in our clinic for prostate adenocarcinoma. Between December 2018 and December 2019, 50 patients who underwent RS-RALP by 2 surgeons in our clinic were enrolled in the study. Preoperative, perioperative, and postoperative clinical data were analyzed retrospectively. Procedure-specific complications were graded according to the Clavien-Dindo classification. The continence status of the patients was recorded in the 1st week, 1st month, and 3rd month after catheter removal. Zero pads or 1 safety pad per day was accepted as total continence. The mean age of the patients was 66.6 (57-75) years. According to the D'Amico classification, 36% of patients were at low risk, 48% at intermediate risk, and 16% at high risk. Bilateral or unilateral nerve-sparing procedure was performed in 76% of the patients. There were no intraoperative complications. A total of 9 (18%) patients had a postoperative complication (7 with grade 1, 1 with grade 2, and 1 with grade 3 complications). Whereas 32% of the patients had an extraprostatic extension, 22% had seminal vesicle invasion. The overall positive surgical margin rate was 26%. At 1 week, 1 month, and 3 months after surgery, 64%, 80%, and 92% of men who underwent RS-RALP were continent, respectively. Our study showed that this new surgical technique can be a safe and feasible method because high rates of early continence were achieved in the patients who underwent RS-RALP without increasing the risk of complications.

Diffusion tensor-based fiber tracking of the male urethral sphincter complex in patients undergoing radical prostatectomy: a feasibility study

ObjectivesTo study the diffusion tensor-based fiber tracking feasibility to access the male urethral sphincter complex of patients with prostate cancer undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP).MethodsTwenty-eight patients (median age of 64.5 years old) underwent 3 T multiparametric-MRI of the prostate, including an additional echo-planar diffusion tensor imaging (DTI) sequence, using 15 diffusion-encoding directions and a b value = 600 s/mm2. Acquisition parameters, together with patient motion and eddy currents corrections, were evaluated. The proximal and distal sphincters, and membranous urethra were reconstructed using the deterministic fiber assignment by continuous tracking (FACT) algorithm, optimizing fiber tracking parameters. Tract length and density, fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were computed. Regional differences between structures were accessed by ANOVA, or nonparametric Kruskal–Wallis test, and post-hoc tests were employed, respectively, TukeyHSD or Dunn’s.ResultsThe structures of the male urethral sphincter complex were clearly depicted by fiber tractography using optimized acquisition and fiber tracking parameters. The use of eddy currents and subject motion corrections did not yield statistically significant differences on the reported DTI metrics. Regional differences were found between all structures studied among patients, suggesting a quantitative differentiation on the structures based on DTI metrics.ConclusionsThe current study demonstrates the technical feasibility of the proposed methodology, to study in a preoperative setting the male urethral sphincter complex of prostate cancer patients candidates for surgical treatment. These findings may play a role on a more accurate prediction of the RS-RARP post-surgical urinary continence recovery rate.

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

BackgroundTo compare the postoperative continence and clinical outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) with non-RS RALP for patients with prostate cancer.MethodsWe searched PUBMED, EMBASE and the Cochrane Central Register from 1999 to 2019 for studies comparing RS-RALP to non-RS RALP for the treatment of prostate cancer. We used RevMan 5.2 to pool the data.ResultsA total of eight studies involving 1620 patients were included in our meta-analysis. No significant difference was found in positive surgical margins (PSM), bilateral nerve-sparing, postoperative hernia, complications, blood loss, or operative time. Postoperative continence was better with RS-RALP compared with non-RS RALP (OR = 1.02, OR: 2.86, 95% CI 1.94–4.20, p < 0.05).ConclusionsRS-RALP had a better recovery of postoperative continence than non-RS RALP. The perioperative outcomes were comparable for the two methods.

MP19-13 THE ANTERIOR URETHROVESCIAL ANGLE MEASURED ON POSTOPERATIVE CYSTOGRAPHY CAN PREDICT URINARY INCONTINENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP19)1 Apr 2020MP19-13 THE ANTERIOR URETHROVESCIAL ANGLE MEASURED ON POSTOPERATIVE CYSTOGRAPHY CAN PREDICT URINARY INCONTINENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Feifei Zhang*, Xuefeng Qiu, and Hongqian Guo Feifei Zhang*Feifei Zhang* More articles by this author , Xuefeng QiuXuefeng Qiu More articles by this author , and Hongqian GuoHongqian Guo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000852.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted laparoscopic radical prostatectomy (RALP) is associated with urinary incontinence. We evaluated early urinary continence in a set of consecutive patients who underwent conventional RALP (CON-RALP) and Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) to identify the useful predictors of postoperative urinary incontinence as determined by postoperative cystography. METHODS: The study consisted of 121 patients who underwent CON-RALP (n=61) and RS-RALP (n=60). Postoperative cystography was performed within7-10 days after RALP. The ratio between the horizontal and longitudinal length (H/L) of the bladder, the position of the urethrovesical junction (UVJ) quantitatively calculated by bladder neck to pubic symphysis(BNPS) ratio, the anterior urethrovesical angle (aUVA), posterior urethrovesical angle (pUVA) as seen on the cystogram were evaluated. Postoperative continence status was defined by no pad or a safety pad usage after catheter removal. The association between these vairables and urinary incontinence was then analyzed. All patients were followed for at least 3 months postoperatively. RESULTS: The demographic, intraoperative data and postoperative pathologic-related information showed no significant difference. The aUVA, pUVA and H/L ratio showed statistical significance. The continence recovery rates differed significantly at 2 weeks, 1 and 2 months. On univariate analysis, patients’ age was independent risk predictor of urinary incontinence. On multivariate analysis, urinary incontinence was significantly associated with H/L ratio, nerve-sparing technique at 2 weeks. At 1 month, the urinary continence was significantly correlated with age, nerve-sparing technique, aUVA. The independent risk factors at 2 month included age, nerve-sparing technique, aUVA, BNPS ratio. The multivariate logistic regression analysis just showed aUVA was related to the urinary incontinence at 3 months postoperatively. CONCLUSIONS: RS-RARP facilitate the recovery of early urinary continence after surgery. A larger aUVA measured on postoperative cystography is a useful and independent predictor for short-term urinary incontinence after RALP. Advanced age, nerve-sparing technique, larger aUVA, larger BNPS ratio, lesser H/L ratio will increase the risk of early urinary incontinence. Source of Funding: the National Natural Science Foundation of China (81772710, 81572519, 81602232) © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e303-e303 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Feifei Zhang* More articles by this author Xuefeng Qiu More articles by this author Hongqian Guo More articles by this author Expand All Advertisement PDF downloadLoading ...

Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

BackgroundRetzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort.MethodsProspectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery.Results3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out.Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP.84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%.34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT.ConclusionsRsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.

PE18 - Retzius-Sparing robot-assisted laparoscopic radical Prostatectomy (RSP): An international survey on surgical details and worldwide diffusion

Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RSP) is an innovative approach for localized prostate cancer treatment. Through an international survey promoted by the European Association of Urology, we collected and described the different surgical details of the centers performing this approach.

A comparative study between Retzius-sparing robot-assisted laparoscopic radical prostatectomy and conventional robot-assisted laparoscopic radical prostatectomy

Objective To compare the postoperative outcomes and early continence rate between conventional robot-assisted laparoscopic radical prostatectomy (RARP) and Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RSRARP). Methods The date from 50 patients who underwent RSRARP and 122 patients who underwent conventional RARP between 2016 September to 2017 included study. Ninety-two patients (forty-six patients in RARP group and forty-six patients in RSRARP group) were collected by propensity-score matching which were performed using eight preoperative variables. Preoperative data of patients in RSRARP group [patients age (67.1±5.7) years, BMI (24.6±2.7)kg/m2, tPSA 10.7 ng/ml (0-40.7 ng/ml), Gleason score 7 points (6-9 points), prostate volume 31.9 ml (10.0-95.4 ml), ECOG score 0 points (0-1 points), urinary domain of EPIC 94.8 points (63.9-100 points), clinical stage from T1cN0M0 to T3aN0M0] and conventional RARP group [patients age (67.2±6.7) years, BMI (25.2±3.1)kg/m2, tPSA 10.7 ng/ml (0-40.7 ng/ml), Gleason score 7 points (6-9 points), prostate volume 36.8 ml (8.9-81.0 ml), ECOG score 0 points (0-1 points), urinary domain of EPIC 95.8 points (63.9-100.0 points), clinical stage from T1cN0M0 to T3aN0M0] had no significant differences. We reviewed console time, estimated blood loss, the rate of leakage, complications, average daily drainage, pathological result, continence, urinary domain of EPIC one month, two months and three months after operation. Results All 92 cases were successfully performed robotically. Mean operation time was significantly more in RARP group than in RSRARP group [(223.9±48.9)min vs. (198.91±34.2)min, P 0.05). Early continence rate one week and one month after surgery was significantly higher in RSRARP group than in RARP group (78% vs. 35%, 91% vs. 79%, P 0.05). Conclusions RSRARP were time-saving, safe and effective for the surgical treatment of localized prostate cancer. It seemed to yield a better outcome regarding early return to urinary continence postoperatively. Key words: Prostatic cancer; Radical prostatectomy; Robot; Retzius space; Continence

Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size.

To investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP). This is a retrospective analysis of 294 patients with organ-confined prostate cancer treated with RS-RALP in a high-volume centre from November 2012 to February 2015. Patients were divided into three groups based on their transrectal ultrasonography estimated PV as follows: group 1, <40 mL (231 patients); group 2, 40-60 mL (47); group 3, >60 mL (16). Perioperative, oncological, and continence outcomes were compared between the three groups. The median [interquartile range (IQR)] PV for each group was; 26.1 (22-31) mL, 45.9 (41-50) mL, and 70 (68-85) mL. Blood loss was higher in group 3 compared to groups 2 and 1; at a median (IQR) of 475 (312-575) mL, 200 (150-400) mL, and 250 (150-400) mL, respectively (P = 0.001). The intraoperative transfusion rate was higher in group 3 patients (P = 0.004), while the complication rate did not differ (P = 0.05). The console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; at a mean (sd) of 100 (35) min, 92 (34.4) min, and 93 (24.8) min, respectively (P = 0.70). Biochemical recurrence and the continence rate did not differ between the three groups (P = 0.89 and P = 0.25, respectively). RS-RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostates. We therefore recommend that surgeons initiate their RS-RALP technique with smaller prostates.